Ranking Canada's COVID-19 Performance: It is Not as Pretty as We Like to Think

 

The IMF has released the October 2020 edition of its fiscal monitor and economic indicator numbers for world economies and its World Economic Outlook report titled “A Long and Difficult Ascent”  paints a pretty gruesome picture of the carnage wrought by the COVID-19 pandemic.  While the global economic growth outlook has improved somewhat from its June 2020 report, it is still projected at -4.4 percent and is surrounded by a fair amount of risk. 

 

However, in the end, performance is relative and what is more interesting is how different advanced economies are expected to fare in 2020.   Moreover, what is also of interest is their performance economically and fiscally relative to their pandemic performance – which certainly should be of interest to Canadians.   Polling results have often indicated that Canadians have largely approved of the way that their governments have responded to COVID-19 and an international ranking places Canada near the top of countries whose public thinks their country has handled COVID-19 well.  How justified is this perception by Canadians?

 

In understanding how well Canada has done dealing with COVID-19, one has to start with how Canada ranks in terms of the severity of the disease which in itself can indicate how good a job Canada has done in limiting its spread.  Figures 1 and 2 plot the ranked total number of COVID-19 cases per 1 million population and the deaths from COVID-19 per 1 million people as of October 17th (as taken from Worldometer) for 35 advanced economies as defined by the IMF.  Cases per 1 million ranged from highs of 32,914 and 25,083 for Israel and the United States to lows of 490 and 376 for Korea and New Zealand respectively.  COVID deaths per million people ranged from highs of 893 and 722 for Belgium and Spain (with the USA third at 675) to lows of 5 for both New Zealand and Singapore.  

 

 

 

 

 

Canada ranks 21^st in total cases per million – putting it in the bottom half of incidence severity – but 10^th highest in deaths per million population putting it in the top third.  So, while Canada was not hit as hard by infections compared to many countries, it was among those seeing higher death rates – largely because of its poor handling of the long-term care sector where over 80 percent of the deaths occurred.  While Canada is not the United States or Spain or Belgium in terms of the incidence and mortality of COVID-19, it is not Australia or New Zealand or Korea either. One might argue being an island helps but it did not help Cyprus or Malta that much.

 

How about the economic impact?  Figures 3 to 6 are based on the IMF October 2020 World Economic Outlook Report.  Figure 3 ranks the 35 advanced economies in terms of their projected 2020 real GDP growth rates and here Canada ranks 24 out of 35.  While everyone is going to see their economy shrink, some are going to be hit worse than others. Canada is basically at the top of the bottom third with an anticipated drop in real GDP for 2020 of -7.1 percent.  Overall, it is sandwiched between highs of -1.8 and -1.9 percent for Lithuania and Korea and lows of -10.6 and -12.8 for Italy and Spain. Figure 4 ranks these same countries according to their estimated 2020 unemployment rate and here Canada is an honorary Mediterranean country where at 9.7 percent it is coming 4^th out of 35 countries – behind Greece, Spain and Italy.  And if one looks at the percentage point increase compared to 2019, Canada’s is a 4 percent point increase.  Based on Figure 5, we are the second worse increase of the 35 advanced countries, behind the Americans who are expected to see a 5.2 percent point rise in their unemployment rate. 

 

 

 

 

 

 

 

Of course, one might think that Canada’s somewhat mediocre performance relative to other advanced countries when it comes to the spread of COVID-19 and its mortality rate may simply be due to the fact that Canada has been a cheapskate in terms of its public spending compared to other countries.  And, by extension, perhaps our economic performance has been so much worse than other advanced economies because our federal and provincial governments have been captured by deficit scolds who have foisted restraint upon Canadians.  Well, put those notions to rest.  When the government deficit to GDP ratios for these advanced economies are ranked in Figure 6, it appears that Canada is finally number one in something – the size of its 2020 government deficit relative to GDP.  It is expected in 2020 to have the largest government deficit to GDP ratio of these 35 advanced economies registering at 19.7 percent. 

 

 

 

Once again, Canada has been spending a lot and seemingly getting relatively much less for its money.  True, we have not done as badly as some countries when it comes to the effects of COVID-19 on our population (unless you are a resident of a long-term care home) but our economy appears to have been fairly hard hit even with the many billions of support and assistance that have been funneled into it.  Why Canadians have to date been so charitable towards their federal and provincial governments when it comes to performance during the COVID-19 pandemic is a bit of a puzzle to me. Perhaps we just like to be nice.

Mortality in the North

Ontario’s Health Quality Council has just released a new report on Health Equity in northern Ontario that shows that Ontario’s northern regions lag behind provincial averages in quality of health and health care.  The geographic focus of the report is on the area that “extends north of Lake Huron to Hudson Bay and James Bay, and from the Quebec border in the east to the Manitoba border in the west, which represent nearly 80% of Ontario’s landmass.”  If you do not want to read the report, there is a pretty good overview in the Globe and Mail.

While northern Ontario has seen health gains over time, it remains that the gap in health indicators between the north and the south is growing and it may be worse than the report suggests because the report’s data is drawn from Statistics Canada’s Community Health Survey, which does not cover Indigenous people living on reserves.  As it stands, the relative gap in mortality rates has grown to 30 percent in 2012 from a 12-17 percent range in 1992.  In 2012, the age standardized mortality rate per 1,000 people was 5.7 in the northwest, 5.7 in the northeast and 4.4 in Ontario.

People in the North West LHIN region have a life expectancy of 78.6 years, compared to 81.5 years in Ontario. People in the North East LHIN region also have a markedly lower life expectancy than Ontario overall, of 79.0 years, or 2.5 years shorter than the Ontario average. The North West LHIN region has nearly double Ontario’s number of potential years of life lost due to avoidable deaths, at 6,023 years lost per 100,000 people over a two-year period, compared to 3,243 years per 100,000 people in Ontario. The North East LHIN region also has considerably higher potential years of life lost due to avoidable deaths than Ontario, at 4,763 years per 100,000 people. People in northern Ontario are more likely to die prematurely due to suicide, circulatory and respiratory disease.

The reasons for these differences are complex.  The north is a sparsely populated region and the vast differences make it difficult to deliver the same level of care one might get in Toronto to smaller isolated communities.  There are also lifestyle factors such as higher smoking, drinking and obesity rates in the north.  For example, the self-reported smoking rate was 26.0% in the North East LHIN region and 22.9% in the North West LHIN region, compared to 17.3% in Ontario.

However, access is also still an an issue.  According to the report: “People in the north are less likely than Ontarians as a whole to report having a family doctor, nurse practitioner or other regular health care provider – 89.2% of people in the North East LHIN region and 83.8% in the North West LHIN region, compared to 93.8% of people in Ontario.”  The Globe and Mail story quotes NDP health critic Frances Gélinas as saying that part of the blame for health-quality gaps between the north and south lies with the Liberal government’s move to concentrate health services and surgeries in “centres of excellence” in big cities in the south.

To that, let me add the following anecdotal observation.  Its not just centralization in the south that may be affecting access to health care in northern Ontario but also concentration of health services and facilities within the north’s few major urban centers themselves.  Take the case of Thunder Bay since the new centralized hospital and new medical school were put into place over a decade ago, there has been a steady migration of health services and facilities to the area around the new hospital on the north side of the city.  Indeed, even the Fort William Clinic is now technically in what used to be the old City of Port Arthur.  Twenty years ago, hospitals, diagnostic facilities and clinics appeared to be much more dispersed across the city’s two north-south population clusters. 

I would like to see a study of if there has been any impact on access to medical services and access particularly for those on the south side of the city to physician visits and diagnostic tests.  Especially, how have seniors with limited mobility and lower income people on the south side continued to access physician appointments and tests.  Do they have a higher rate of cancellation?  Would the south side benefit from having an Urgent Care Access Center like the types that have been springing up in southern Ontario cities? Perhaps there has been no change but I would like to see some evidence based results because my gut feeling is that it is much harder to access care even in the north’s larger urban centers and the result is fewer people going to see doctors and getting tests.  Moreover, those most likely to not make it to the doctor may be among more vulnerable populations. However, gut feelings are not enough to make policy. We need evidence.